Healthcare Provider Details

I. General information

NPI: 1841986858
Provider Name (Legal Business Name): SARA KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY ST
MUSKOGEE OK
74401-6245
US

IV. Provider business mailing address

PO BOX 1536
MUSKOGEE OK
74402-1536
US

V. Phone/Fax

Practice location:
  • Phone: 918-681-7555
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number313
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: